Factors correlated with financial hardship among cancer patients during the COVID-19 pandemic

Purpose: Financial hardship from cancer care is associated with poor patient outcomes. Economic disruption during the COVID-19 pandemic may have exacerbated patients’ financial concerns. We explore how social deprivation index (SDI), clinical, and treatment-related factors impacted financial hardship in this observational secondary analysis using data collected prospectively during implementation of financial hardship screening from our NCI-designated center during COVID-19. Methods: Adults aged ≥18 years undergoing active treatment for stage 0-IV breast or lung cancer and who completed a 5-point Likert response-item screening for financial difficulty between 11/2020 and 11/2021 were included. Generalized estimating equations assessed associations between quartiles of zip-code level SDI, a composite obtained using data from US Census and American Community Survey, and binary outcome of financial hardship adjusting for relevant covariates. Results: Of 2245 patients, 87% identified as White, 9% as Black, 2% as Asian. The majority of patients identified as non-Hispanic (99%). Median age was 62 years old (IQR 53–71).The majority were treated for breast cancer (79%). Significant financial hardship (Likert responses ≥2) was reported by 7%. Most were married, had managed-care insurance, resided in urban settings, and had early-stage cancers (all p